Bone density, microarchitecture and stiffness in Caucasian and Caribbean Hispanic postmenopausal American women

Abstract

Hispanic Americans of Caribbean origin are a fast-growing subset of the US population, but there are no studies on bone density, microstructure and biomechanical integrity in this minority group. In this study, we aimed to compare Caucasian and Caribbean Hispanic postmenopausal American women with respect to these characteristics. Thirty-three Caribbean Hispanics were age-matched to thirty-three Caucasian postmenopausal women. At the lumbar spine, the Hispanic women had significantly lower areal bone mineral density (aBMD). At the radius by high-resolution peripheral quantitative computed tomography (HR-pQCT), there were minimal differences between Hispanic and Caucasian women. At the tibia, Hispanic women had lower trabecular volumetric bone density and trabecular number, and higher trabecular separation. Individual trabecula segmentation (ITS) analyses indicated that at the tibia, Hispanic women not only had significantly lower bone volume fraction, but also had significantly lower rod bone volume fraction, plate trabecular number, rod trabecular number and lower plate–plate, plate–rod and rod–rod junction densities compared to Caucasian women. The differences in bone quantity and quality contributed to lower whole bone stiffness at the radius, and both whole bone and trabecular bone stiffness at the tibia in Hispanic women. In conclusion, Hispanic women had poorer bone mechanical and microarchitectural properties than Caucasian women, especially at the load-bearing distal tibia.

Bone structure: Caribbean Hispanic women have weaker bones

A study of American post-menopausal women has revealed weaker bones in Caribbean Hispanics than Caucasians, increasing the risk of fracture. Bone properties vary between ethnic groups but little is known about the bones of Caribbean Hispanic women, a growing population in the US. Led by Edward Guo and Elizabeth Shane at Columbia University, USA, researchers analyzed the mineral density and microstructure of the bones of 33 post-menopausal women in each ethnic group. They found that the Hispanic women had lower mineral density in the lower spine, while the microstructure of the tibia, or shinbone, showed differences that cause lower bone stiffness. This small-group study suggests that the population of Caribbean Hispanic women in the USA is at increased risk of post-menopausal fractures and that larger population-based studies are needed.

References

[1] Nam HS, Kweon SS, Choi JS et al Racial/ethnic differences in bone mineral density among older women. J Bone Miner Metab, 2013, 31: 190-198

[2] Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res, 2007, 22: 465-475

[3] Cauley JA, Lui LY, Ensrud KE et al Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA, 2005, 293: 2102-2108

[4] Cauley JA, Wu L, Wampler NS et al Clinical risk factors for fractures in multi-ethnic women: the Women’s Health Initiative. J Bone Miner Res, 2007, 22: 1816-1826

[5] Cummings SR, Cauley JA, Palermo L et al Racial differences in hip axis lengths might explain racial differences in rates of hip fracture. Osteoporos Int, 1994, 4: 226-229

[6] Mackey DC, Eby JG, Harris F et al Prediction of clinical non-spine fractures in older black and white men and women with volumetric BMD of the spine and areal BMD of the hip: the Health, Aging, and Body Composition Study. J Bone Miner Res, 2007, 22: 1862-1868

[7] Nelson DA, Barondess DA, Hendrix SL, Beck TJ. Cross-sectional geometry, bone strength, and bone mass in the proximal femur in black and white postmenopausal women. J Bone Miner Res, 2000, 15: 1992-1997

[8] Barrett-Connor E, Siris ES, Wehren LE et al Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res, 2005, 20: 185-194

[9] Hochberg MC. Racial differences in bone strength. Trans Am Clin Climatol Assoc, 2007, 118: 305-315

[10] Looker AC, Melton LJ 3rd, Harris TB, Borrud LG, Shepherd JA. Prevalence and trends in low femur bone density among older US adults: NHANES 2005–2006 compared with NHANES III. J Bone Miner Res, 2010, 25: 64-71

[11] Nelson DA, Beck TJ, Wu G et al Ethnic differences in femur geometry in the women’s health initiative observational study. Osteoporos Int, 2011, 22: 1377-1388

[12] Peralta CA, Li YM, Wassel C et al Differences in albuminuria between Hispanics and Whites: an evaluation by genetic ancestry and country of origin the multi-ethnic study of atherosclerosis. Circ Cardiovasc Genet, 2010, 3: 240-247

[13] Fields AJ, Eswaran SK, Jekir MG, Keaveny TM. Role of trabecular microarchitecture in whole-vertebral body biomechanical behavior. J Bone Miner Res, 2009, 24: 1523-1530

[14] Fields AJ, Lee GL, Liu XS, Jekir MG, Guo XE, Keaveny TM. Influence of vertical trabeculae on the compressive strength of the human vertebra. J Bone Miner Res, 2011, 26: 263-269

[15] Liu XS, Cohen A, Shane E et al Individual trabeculae segmentation (ITS)-based morphological analysis of high-resolution peripheral quantitative computed tomography images detects abnormal trabecular plate and rod microarchitecture in premenopausal women with idiopathic osteoporosis. J Bone Miner Res, 2010, 25: 1496-1505

[16] Liu XS, Sajda P, Saha PK et al Complete volumetric decomposition of individual trabecular plates and rods and its morphological correlations with anisotropic elastic moduli in human trabecular bone. J Bone Miner Res, 2008, 23: 223-235

[17] Liu XS, Sajda P, Saha PK, Wehrli FW, Guo XE. Quantification of the roles of trabecular microarchitecture and trabecular type in determining the elastic modulus of human trabecular bone. J Bone Miner Res, 2006, 21: 1608-1617

[18] Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA, 2009, 302: 1573-1579

[19] Zingmond DS, Melton LJ 3rd, Silverman SL. Increasing hip fracture incidence in California Hispanics, 1983 to 2000. Osteoporos Int, 2004, 15: 603-610

[20] Wright NC, Saag KG, Curtis JR et al Recent trends in hip fracture rates by race/ethnicity among older US adults. J Bone Miner Res, 2012, 27: 2325-2332

[21] Cauley JA. Defining ethnic and racial differences in osteoporosis and fragility fractures. Clin Orthop Relat Res, 2011, 469: 1891-1899

[22] Liu XS, Zhang XH, Sekhon KK et al High-resolution peripheral quantitative computed tomography can assess microstructural and mechanical properties of human distal tibial bone. J Bone Miner Res, 2010, 25: 746-756

[23] Nishiyama KK, Macdonald HM, Buie HR, Hanley DA, Boyd SK. Postmenopausal women with osteopenia have higher cortical porosity and thinner cortices at the distal radius and tibia than women with normal aBMD: an in vivo HR-pQCT study. J Bone Miner Res, 2010, 25: 882-890

[24] Stein EM, Liu XS, Nickolas TL et al Abnormal microarchitecture and reduced stiffness at the radius and tibia in postmenopausal women with fractures. J Bone Miner Res, 2010, 25: 2572-2581

[25] Vu TD, Wang XF, Wang Q et al New insights into the effects of primary hyperparathyroidism on the cortical and trabecular compartments of bone. Bone, 2013, 55: 57-63

[26] Walker MD, Liu XS, Stein E et al Differences in bone microarchitecture between postmenopausal Chinese-American and white women. J Bone Miner Res, 2011, 26: 1392-1398

[27] Walker MD, Saeed I, McMahon DJ et al Volumetric bone mineral density at the spine and hip in Chinese American and White women. Osteoporos Int, 2012, 23: 2499-2506

[28] Liu XS, Walker MD, McMahon DJ et al Better skeletal microstructure confers greater mechanical advantages in Chinese-American women versus white women. J Bone Miner Res, 2011, 26: 1783-1792

[29] Cong E, Walker MD. The Chinese skeleton: insights into microstructure that help to explain the epidemiology of fracture. Bone Research, 2014, 2: 14009

[30] Liu XS, Cohen A, Shane E et al Bone density, geometry, microstructure, and stiffness: relationships between peripheral and central skeletal sites assessed by DXA, HR-pQCT, and cQCT in premenopausal women. J Bone Miner Res, 2010, 25: 2229-2238

[31] Stein EM, Liu XS, Nickolas TL et al Microarchitectural abnormalities are more severe in postmenopausal women with vertebral compared to nonvertebral fractures. J Clin Endocrinol Metab, 2012, 97: E1918-E1926

[32] Stein Emily M., Liu X. Sherry, Nickolas Thomas L., Cohen Adi, Thomas Valerie, McMahon Donald J., Zhang Chiyuan, Cosman Felicia, Nieves Jeri, Greisberg Justin, Guo X. Edward, Shane Elizabeth. Abnormal Microarchitecture and Stiffness in Postmenopausal Women with Ankle Fractures. The Journal of Clinical Endocrinology & Metabolism, 2011, 96 7 2041-2048

[33] Boutroy S, Bouxsein ML, Munoz F, Delmas PD. In vivo assessment of trabecular bone microarchitecture by high-resolution peripheral quantitative computed tomography. J Clin Endocrinol Metab, 2005, 90: 6508-6515

[34] Laib A, Hauselmann HJ, Ruegsegger P. In vivo high resolution 3D-QCT of the human forearm. Technol Health Care, 1998, 6: 329-337

[35] Saha PK, Chaudhuri BB, Dutta D, Majumder DD. A new shape preserving parallel thinning algorithm for 3D digital images. Pattern Recog, 1997, 30: 1939-1955

[36] Saha PK, Chaudhuri BB, Chanda B, Majumder DD. Topology preservation in 3D digital space. Patt Recog, 1994, 27: 295-300

[37] Saha PK, Chaudhuri BB. 3D digital topology under binary transformation with applications. Comput Vis Image Understand, 1996, 63: 418-429

[38] Saha PK, Chaudhuri BB. Detection of 3-D simple points for topology preserving transformations with application to thinning. IEEE Trans Pattern Anal Mach Intell, 1994, 16: 1028-1032

[39] Liu XS, Shane E, McMahon DJ, Guo XE. Individual trabecula segmentation (ITS)-based morphological analysis of microscale images of human tibial trabecular bone at limited spatial resolution. J Bone Miner Res, 2011, 26: 2184-2193

[40] Guo XE, Goldstein SA. Is trabecular bone tissue different from cortical bone tissue? Forma, 1997, 12: 185-196

[41] Macneil JA, Boyd SK. Bone strength at the distal radius can be estimated from high-resolution peripheral quantitative computed tomography and the finite element method. Bone, 2008, 42: 1203-1213

[42] Stein EM, Liu XS, Nickolas TL et al Abnormal microarchitecture and reduced stiffness at the radius and tibia in postmenopausal women with fractures. J Bone Miner Res, 2010, 25: 2572-2581

[43] Melton LJ 3rd, Christen D, Riggs BL et al Assessing forearm fracture risk in postmenopausal women. Osteoporos Int, 2010, 21: 1161-1169

[44] Vilayphiou N, Boutroy S, Sornay-Rendu E et al Finite element analysis performed on radius and tibia HR-pQCT images and fragility fractures at all sites in postmenopausal women. Bone, 2010, 46: 1030-1037

[45] Hollister SJ, Brennan JM, Kikuchi N. A homogenization sampling procedure for calculating trabecular bone effective stiffness and tissue level stress. J Biomech, 1994, 27: 433-444

[46] Morton DJ, Barrett-Connor E, Kritz-Silverstein D, Wingard DL, Schneider DL. Bone mineral density in postmenopausal Caucasian, Filipina, and Hispanic women. Int J Epidemiol, 2003, 32: 150-156

[47] Taaffe DR, Villa ML, Holloway L, Marcus R. Bone mineral density in older non-Hispanic Caucasian and Mexican-American women: relationship to lean and fat mass. Ann Hum Biol, 2000, 27: 331-344

[48] Putman MS, Yu EW, Lee H et al Differences in skeletal microarchitecture and strength in African-American and white women. J Bone Miner Res, 2013, 28: 2177-2185

[49] Liu XS, Cohen A, Shane E et al Individual trabeculae segmentation (ITS)-based morphological analyses of high resolution peripheral quantitative computed tomography images detect abnormal trabecular plate and rod microarchitecture in premenopausal women with idiopathic osteoporosis. J Bone Miner Res, 2010, 25: 1496-1505

[50] Walker MD, Liu XS, Zhou B et al Premenopausal and postmenopausal differences in bone microstructure and mechanical competence in Chinese-American and white women. J Bone Miner Res, 2013, 28: 1308-1318

[51] Looker AC, Orwoll ES, Johnston CC Jr et al. . Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res, 1997, 12: 1761-1768

[52] Mohamed EI, Tarantino U, Promenzio L, de Lorenzo A. Predicting bone mineral density of postmenopausal healthy and cirrhotic Italian women using age and body mass index. Acta Diabetol, 2003, 40 Suppl 1 S23-S28

[53] Putman MS, Milliren CE, Derrico N et al Compromised bone microarchitecture and estimated bone strength in young adults with cystic fibrosis. J Clin Endocrinol Metab, 2014, 99: 3399-3407

[54] Zhou B, Liu XS, Wang J, Lu XL, Fields AJ, Guo XE. Dependence of mechanical properties of trabecular bone on plate–rod microstructure determined by individual trabecula segmentation (ITS). J Biomech, 2014, 47: 702-708

[55] Hall JB, Dumitrescu L, Dilks HH, Crawford DC, Bush WS. Accuracy of administratively-assigned ancestry for diverse populations in an electronic medical record-linked biobank. PLoS One, 2014, 9: e99161

[56] MacNeil JA, Boyd SK. Accuracy of high-resolution peripheral quantitative computed tomography for measurement of bone quality. Med Eng Phys, 2007, 29: 1096-1105